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Allergy & Rhinology (1)
American journal of rhinology (1)
Carter, Cody S. (1)
Conley, David B. (1)
Grammer, Leslie C. (1)
Harris, Kathleen (1)
Kern, Robert C. (1)
Paniagua, Mary C. (1)
Schleimer, Robert P. (1)
Seiberling, Kristin (1)
Seiberling, Kristin A. (1)
Stewart, Thomas A. (1)
Suh, Lydia A. (1)
Tripathi, Anju (1)
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Temporal lobe abscess in a patient with isolated sphenoiditis
Stewart, Thomas A.
Carter, Cody S.
Allergy & Rhinology
A 74-year-old immunocompetent man admitted for severe retro-orbital headache was diagnosed with isolated sphenoiditis. At the time of scheduled surgery, the patient was mildly obtunded, and a head CT revealed a temporal lobe abscess. The patient underwent a left temporal craniectomy and a bilateral endoscopic sphenoid sinusotomy, which revealed gross fungal debris. The patient made a full recovery with resolution of abscess and sinus findings. Suspicion for intracranial infection should be raised in any sinus patient with neurological changes. Early diagnosis with imaging studies is extremely important for surgical drainage before permanent neurological sequelae.
Abcess; allergic sinusitis; fungal infection; headache; sinonasal; sphenoiditis; temporal lobe
Superantigens and chronic rhinosinusitis: Skewing of T-cell receptor Vβ-distributions in polyp-derived CD4+ and CD8+ T cells
Conley, David B.
Schleimer, Robert P.
Suh, Lydia A.
Paniagua, Mary C.
Grammer, Leslie C.
Kern, Robert C.
American journal of rhinology
Recent studies have suggested that Staphylococcus aureus secrete superantigenic toxins that play a role in the etiology of chronic rhinosinusitis with nasal polyposis (CRSwNP). Twenty S. aureus superantigens (SAg’s) have been identified, each of which bind the Vβ-region of the T-cell receptor (TCR) outside the peptide-binding site. Approximately 50 distinct Vβ-domains exist in the human repertoire, and distinct SAg’s will bind only particular domains generating a pattern of Vβ-enrichment in lymphocytes dependent on the binding characteristics of a given toxin. The aim of this study was to analyze the pattern of Vβ-expression in polyp-derived lymphocytes from CRSwNP patients.
Polyps were harvested from 20 patients with CRSwNP and 3 patients with antrochoanal polyps. Flow cytometry was used to analyze the Vβ-repertoire of polyp-derived CD4+ and CD8+ lymphocytes. Data were analyzed in light of the known skewing associated with SAg exposure in vivo and in vitro. Skewing was defined as a percentage of Vβ-expression >2 SD of that seen in normal blood.
Seven of 20 subjects exhibited skewing in Vβ-domains with strong associations with S. aureus SAg’s. The three antrochoanal polyps failed to show any significant Vβ-skewing.
This study establishes evidence of S. aureus SAg–T-cell interactions in polyp lymphocytes of 35% of CRSwNP patients. Although these results are consistent with intranasal exposure of polyp lymphocytes to SAg’s, additional study is necessary to establish the role of these toxins in disease pathogenesis.
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